John Anderson, MD, discusses the management of quality care for patients with CKD.
Ryan Haumschild, PharmD, MS, MBA: Dr Anderson, you talked about some of these quality measures earlier. So I’d love to hear your thoughts on the HEDIS [Healthcare Effectiveness Data and Information Set] and MIPS [Merit-Based Incentive Payment System] quality measures. How can our primary care providers and nephrologists collaborate to meet these goals?
John E. Anderson, MD: Physicians want to get paid. And so I think there is a real benefit to meeting the criteria for HEDIS measures and getting paid. I also think there are penalties for not doing so. But the whole collaboration of care between the primary care world and the nephrology world…has not been ideal either. I see a lot of patients and I refer to a lot of people. If you’ve got a bad ankle, you go to the orthopedist, right? I’m not even going to pick up the phone. But if I’ve got somebody who’s got stage 3B CKD [chronic kidney disease] and type 2 diabetes, they need a wealth of information from me. They need the most recent…data. We need to look at the trends in uACR [urine albumin-creatinine ratio] or they need a medication list. They need to know their [hemoglobin] A1C. There needs to be a whole profile that goes with that patient to the first nephrology visit, unlike many of our other specialists. So I think it’s incumbent upon us to understand, to put our specialists in the best ability to have an effective first visit with that patient, but already having the information sitting there so that they don’t have to then draw the same laboratory and get back with the patient later when they see the [results] for the first time. We have to set our specialists up for success when we’re referring to them. The other thing you said, when you refer to nephrology: If you’re not comfortable with guideline-directed therapy, refer them to somebody who knows or is more comfortable in doing so regardless of where they are…. [A patient who] has markedly nephrotic syndrome market elevations uACR from one year to the next, rapid deterioration of renal function. You need to get that person seen immediately because that may not be type 2 diabetes, that may not be hypertension. You may be dealing with a whole other type of nephropathy. So I think in primary care, have your eyes open and when something looks a little unusual, make sure you’re getting help.
Transcript is AI-generated and edited for clarity and readability.
Integrated Care for Chronic Conditions: A Randomized Care Management Trial
December 3rd 2025The authors sought to understand the differential impact of payer-led community-based care management approaches on stakeholder-oriented outcomes for publicly insured adults with multiple chronic conditions.
Read More
Managed Care Reflections: A Q&A With A. Mark Fendrick, MD, and Michael E. Chernew, PhD
December 2nd 2025To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The December issue features a conversation with AJMC Co–Editors in Chief A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design and a professor at the University of Michigan in Ann Arbor; and Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and the director of the Healthcare Markets and Regulation Lab at Harvard Medical School in Boston, Massachusetts.
Read More